American Heart Journal
Volume 153, Issue 1 , Pages 98-104, January 2007

Use and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure

  • Uri Elkayam, MD

      Affiliations

    • University of Southern California, Los Angeles, CA
    • Corresponding Author InformationReprint requests: Uri Elkayam, MD, Heart Failure Program, USC School of Medicine, 2025 Zonal Ave, GH 7440, Los Angeles, CA 90033.
    • ,
  • Gudaye Tasissa, PhD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Cynthia Binanay, RN, BSN

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Lynne W. Stevenson, MD

      Affiliations

    • Brigham and Women's Hospital, Boston, MA
    • ,
  • Mihai Gheorghiade, MD

      Affiliations

    • Northwestern University, Feinberg School of Medicine, Chicago, IL
    • ,
  • J. Wayne Warnica, MD

      Affiliations

    • University of Calgary, Calgary, Alberta, Canada
    • ,
  • James B. Young, MD

      Affiliations

    • Cleveland Clinic Foundation, Cleveland, OH
    • ,
  • Barry K. Rayburn, MD

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Joseph G. Rogers, MD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Teresa DeMarco, MD

      Affiliations

    • University of California at San Francisco Medical Center, San Francisco, CA
    • ,
  • Carl V. Leier, MD

      Affiliations

    • The Ohio State University, College of Medicine and Public Health, Columbus, OH

Received 31 May 2006; accepted 20 September 2006. published online 13 November 2006.

Background

Treatment of decompensated heart failure often includes the use of intravenous vasoactive medications, but the effect on outcome has not been clearly defined.

Methods

Data from 433 patients enrolled in the ESCAPE trial were analyzed to determine 6-month risks of all-cause mortality and all-cause mortality plus rehospitalization associated with the use of vasodilators, inotropes, and their combination. Patients had a mean left ventricular ejection fraction of 19%, 6-minute walk distance of 414 ft, and systolic blood pressure of 106 mm Hg. The main outcome measure was multivariable risk-adjusted 6-month hazard ratios (HRs).

Results

Overall 6-month mortality was 19%. Risk-adjusted HRs were not statistically significant for vasodilators (1.39, 95% CI 0.64-3.00), but were significant for inotropes (2.14, 95% CI 1.10-4.15) and the combination (4.81, 95% CI 2.34-9.90). Risk-adjusted 6-month mortality plus rehospitalization HRs were not significant for vasodilators (1.20, 95% CI 0.81-1.78, P = .37), but were significant for inotropes (1.96, 95% CI 1.37-2.82, P < .001) and their combination (2.90, 95% CI 1.88-4.48, P = .001). The decision to use vasodilators or inotropes was determined by hemodynamic parameters and renal function, but the main factor was treatment site.

Conclusions

In ESCAPE, the choice of medications was mainly determined by the treatment site. Use of inotropic agents was associated with adverse outcomes, whereas the use of vasodilators was not. Inotropes in combination with vasodilators identified a group with the highest mortality. Prospective studies are needed to establish the appropriate use of vasoactive medications in this population.

 

 This study was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.

PII: S0002-8703(06)00826-X

doi:10.1016/j.ahj.2006.09.005

American Heart Journal
Volume 153, Issue 1 , Pages 98-104, January 2007

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